CBEMT

My point is, if it's working why mess with it? Does the patient not deserve the benefit of the doubt once in the hospital?

Any study done on the Autopulse done so far isn't worth the paper it's printed on. NONE of them have taken into account the fact that as soon as the patient hits the ED, they're taken off the device, but if they still need CPR, it's done by a human. It would be like testing patient outcomes with Epi 1:10,000 in the field but using Vasopressin in the hospital.

It's happened to me, and seeing as how my employer at the time chose to not to provide me with either versed or morphine, my remaining option was NPA, BVM and run. At the ER, the patient was intubated without any drugs at all (after one failed attempt and one gut tube by a PA). I could hear the patient gagging on the blade every time. "Hell," I thought. "If I knew that's how they were gonna play, I'd have done it ten minutes ago. Least I could've done it in one shot." Then I put my ego back in the box and decided that I should've taken the extra 5 minutes and gone to another hospital to begin with. Think bigger. Like, regions. But they don't have RSI anyway, so.... No argument from me. But we're also talking about a system that requires EOA's on every ambulance, but not glucometers, SPO2, or 12-leads.

Nope, and I hope it stays that way, for a lot of reasons. Just the idea of snowing somebody with versed/morphine for the purposes of intubation is not an idea that would ever cross the minds of 90% of our ALS providers (0.001% of whom are medics so that might explain it). The possibility I mentioned is only glossed over in the protocols, it's clearly not something they expect people to even think about since our standard ALS provider's normal intubation requirement is actual respiratory arrest. Anything else, by the letter of the law, requires Med Control. Not that it always happens that way. But it does say it's an option, so those of us non-medics with a brain always keep it open as an option. If it comes down to it we'll make the call, try to get the clearance, and do the best we can.

"So, let me just make sure I'm hearing you correctly- you want me to transport you to (city across the state line, about 10 miles) to get your prescriptions because your daughter has a cold and can't drive you?" "Yeah!" "So you don't want to go to a hospital?" "Nope." "Sign here."

Yeah, that's the one I worry about. Best I could do is call Med Control and beg for an order of Versed and Morphine.

Unfortunately, at my part-time gig, that order IS in writing. :roll: That said, depending on the time of day it could save us as much as 15-20 minutes. Still, I'll grant you, usually not clinically significant. I have no qualms about telling our drivers to slow down.

You aren't kidding. MacGyver could take over the world with an arsenal like that! :shock:

Fire departments: Rescue Privates: Squad, Unit, or Med depending which company.

Lol, yeah expedite. Because dispatch gave the facility a 20-minute ETA knowing full well they didn't have a truck within 30 minutes of the place. And if they get in a crash dispatcher says "I never told them to do that."

What the hell are you talking about? Who said anything about an emergency response? Oh, that's right- all volunteers are the same, and they all have whackermobiles and drive a hundred miles an hour. I forgot. Couldn't POSSIBLY be that you don't, in fact, know everything.

I've heard of some VFDs that give a few members wives, mothers, etc a pager, and they respond to the firehouse and watch anybody's kids that need an emergency sitter while they go on the call. I think in one case it was the chief's wife (who was a grandmother).

I personally prefer... Scenery is much better.

A good reason to have nothing on your car that might identify you as any provider on that list. In the old days in Massachusetts, doctors had special plates that marked them as MDs. Problem for them was the State/local PDs would often stop them and have them assist at MVAs and the like. So all the doctors started swapping cars with their wives.

Manpower permitting, send somebody to a neighbor's. Gotta be careful with that though, soooo many people have NO idea they're living next door to Urkin the town rapist (naughty naughty!).

Ada County, Idaho Durham County and Wake County, NC Austin TX, as Dust (somewhat) alluded to. Boston MA, Worcester MA, New Bedford MA New Britain EMS, New Britain CT Pretty sure all the hospital-based ALS services in New Jersey have retirement.

Well than I guess I can take heart at the knowledge that despite how fracked-up EMS is in my state, and how "detrimental to the profession" some of my opinions have been judged to be here, at least my Basic students aren't leaving our school until they know exactly that information. We have a real biatch of an Airway instructor.

Does Dr. Bledsoe know how horrible it supposedly is?

Hmm. Well, I'm never one to advocate getting information from only one source. I spose I could always get a subscription to Fire-EMS... :twisted: Obviously, EMS providers could do a lot worse than JEMS. Like, say, not taking the initiative or money to read any EMS publications at all.

I've never advocated cutting the size of fire departments, and I don't think we as EMS should be doing that. Fires, when they happen, are very manpower-intensive. Multiple studies have shown that efficiency decreases and injuries increase as the number of ffs per company is lowered. Sure, some departments do it with much less but they truly are taking unacceptably large risks. Instead of trying to gut fire departments just because we think firefighters are dumb and don't work enough, we should be concentrating on increasing EMS resources- for everyone's benefit.

With no RSI option here, I predict a very long 20 minute transport ahead of me....

I've had plenty of fully oriented patients who I considered too intoxicated to refuse, so I transported. It's about clinical judgment and decision-making.

I'll do you one better- in Worcester there are buildings with EMS override switches in their elevators, just like the FD override switches. Complete with keys carried by WEMS.

Having the patient demographic info (including social and insurance for repeat customers) available prior to arrival was nice (private service). As for the routing, I didn't trust that thing any farther than I could throw it. It was horrible.

If I called a doc for every one of those cases I'd never get anything done. At my full time job I'd be at the hospital before I dialed the phone. It's just like the line in our protocols that require Med Control for Albuterol (some people read it as "All EMTs" some read it as "BLS providers). Either way, nobody here knows anybody else at any level who's ever done it. The only time we talk to an MD is for things we need orders for. Everything else goes through the triage nurse, except at the trauma center. Their nurses don't want to hear a word out of you unless you need a Critical room.